Addiction [JOURNAL]
Sun
200 papers
Seeing through a glass darkly.
Sinclair JMA
Addiction · 2026 May · PMID 41582003 · Publisher ↗
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Pharmacological treatment strategies to manage precipitated withdrawal following the administration of buprenorphine in opioid use disorder: A systematic review.
Roberts E, Kalk N, Strang J
Addiction · 2026 May · PMID 41571617 · Full text
BACKGROUND AND AIMS: There has been limited evidence synthesis examining the treatment of buprenorphine precipitated opioid withdrawal (BPOW). We aimed to conduct the first systematic review to assess the clinical utilit...
BACKGROUND AND AIMS: There has been limited evidence synthesis examining the treatment of buprenorphine precipitated opioid withdrawal (BPOW). We aimed to conduct the first systematic review to assess the clinical utility of any pharmacological intervention in the management of BPOW. METHODS: Systematic review searching Medline, Embase, PsychINFO and CENTRAL from the date of database inception to 26 August 2025 for studies of any design reporting any pharmacological intervention in the management of BPOW compared with any or no other interventions, using adult participants aged 18 or over receiving buprenorphine and experiencing BPOW. We planned to combine outcomes using random-effects meta-analysis; where this was not possible results were reported narratively. We considered two outcomes and extracted (1) any reported measure or description of the change in opioid withdrawal symptoms (OWS) and (2) the number of individuals retained in buprenorphine treatment. Outcome quality was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. RESULTS: Forty-three studies met inclusion criteria reporting on 137 participants. These comprised one pilot randomised controlled trial and 42 uncontrolled observational case series or case reports. Meta-analysis was not possible, and all evidence was of low or very low quality. The currently available randomised evidence suggests that use of intravenous magnesium sulphate, in addition to symptomatic treatment with clonidine, paracetamol and diazepam, may statistically significantly reduce OWS when compared with symptomatic treatment alone. The currently available observational evidence suggests that treatment strategies which include additional doses of transmucosal buprenorphine may demonstrate higher rates of symptom control and treatment retention than strategies which do not include additional doses of transmucosal buprenorphine. CONCLUSIONS: There is a paucity of research into pharmacological management of buprenorphine precipitated opioid withdrawal. The limited very low to low quality evidence suggests treatment regimens that include magnesium sulphate and additional doses of transmucosal buprenorphine are potentially the most salient current options and avenues for future research in the management of buprenorphine precipitated opioid withdrawal.
Atipamezole merits investigation for use in human α-2 agonist toxicity.
Blumenberg A, Murphy L
Addiction · 2026 May · PMID 41571610 · Publisher ↗
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Commentary on Dowd et al.: Beyond single data sources-Consistency checking and evidence synthesis for prevalence estimation.
Jones HE, Markoulidakis A, Hickman M
Addiction · 2026 Apr · PMID 41566157 · Publisher ↗
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Continuing use of e-cigarettes after stopping smoking and relapse: Secondary analysis of a large randomised controlled trial.
Hajek P, Przulj D, Myers Smith K … +6 more , Li J, Sasieni P, Ross L, McRobbie H, Goniewicz M, Pesola F
Addiction · 2026 Apr · PMID 41560608 · Full text
BACKGROUND AND AIMS: Smokers quitting successfully with the help of e-cigarettes often continue vaping. It is not known whether this promotes or prevents relapse back to smoking. This study aimed to determine whether use...
BACKGROUND AND AIMS: Smokers quitting successfully with the help of e-cigarettes often continue vaping. It is not known whether this promotes or prevents relapse back to smoking. This study aimed to determine whether use of e-cigarettes after successful smoking cessation affects the probability of relapse later on. DESIGN: Secondary analysis of a randomised controlled trial where participants received combination nicotine replacement therapy (NRT) or e-cigarettes to compare relapse rates in the two study arms and in abstainers who did and did not use e-cigarettes. SETTING: Four stop-smoking services in the United Kingdom. PARTICIPANTS: 886 smokers (median age 41, smoking on average 15 cigarettes per day, 48% female) seeking help with stopping smoking. MEASUREMENTS: Main outcome was relapse to smoking by 12 months in participants who were abstinent at 4 weeks or at 6 months. Relapse was defined as abstinence at 4 weeks but not at one year or abstinence at 6 months but not at one year. Abstinence from smoking was defined as no smoking over the past 7 days. E-cigarette use was defined as using e-cigarettes at the time of abstinence on at least one day per week. FINDINGS: Abstainers in the e-cigarette arm were less likely to relapse than abstainers in the NRT arm [relative risk (RR) = 0.78, 95% confidence interval (CI) = 0.64-0.96 for relapse between 4 weeks and 1 year; RR = 0.71, 95% CI = 0.55-0.93 for relapse between 6 months and 1 year). Relapse rates over both time periods were also lower in abstainers who used e-cigarettes compared with abstainers who did not use e-cigarettes (RR = 0.79, 95% CI = 0.65-0.97 and RR = 0.75, 95% CI = 0.57-0.98, respectively). CONCLUSIONS: Use of e-cigarettes after stopping smoking is associated with a reduced risk of relapse.
Rare but relevant: Ibogaine and cardiovascular complications-prolonged QT interval and ventricular arrhythmias.
Brunt TM
Addiction · 2026 Jun · PMID 41560340 · Full text
Revived interest in psychedelic-assisted therapies has also renewed focus on ibogaine, a psychoactive alkaloid, for its notable anti-addictive potential. Evidence from observational, open-label, and limited randomized pl...
Revived interest in psychedelic-assisted therapies has also renewed focus on ibogaine, a psychoactive alkaloid, for its notable anti-addictive potential. Evidence from observational, open-label, and limited randomized placebo-controlled trials indicates that ibogaine and its metabolite noribogaine reduce craving and withdrawal symptoms in opioid and cocaine-dependent individuals, primarily through multiple pharmacological mechanisms; however, ibogaine presents a rare yet clinically significant cardiotoxic risk: QTc prolongation and potentially fatal ventricular arrhythmias such as Torsades des Pointes. Case reports demonstrate that these events occur with therapeutic doses of ibogaine and in individuals without pre-existing cardiac conditions. A large interindividual variability in CYP2D6 metabolism of ibogaine was shown and might contribute to higher cardiovascular risk in certain individuals. Recent efforts to improve safety of ibogaine include different dosing strategies, cardiovascular monitoring and the development of ibogaine analogues, which retain anti-addictive efficacy while lacking cardiotoxicity in preclinical models. Future ibogaine-assisted treatment should be conducted exclusively under controlled medical supervision, with CYP2D6 genotyping and rigorous monitoring of cardiovascular functioning. Future clinical trials should prioritize evaluation of safer analogues and personalized dosing strategies to optimize the benefit-risk profile of this emerging therapy.
Distinguishing chronic disease profiles and cause of death attribution in opioid and or stimulant toxicity deaths to inform overdose prevention efforts.
Palis H, Vincent J, Budau J … +2 more , Hu K, Tu A
Addiction · 2026 May · PMID 41560316 · Publisher ↗
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Retention in opioid agonist treatment during pregnancy and variations according to treatment and maternal characteristics.
Varney B, Jones N, Bharat C … +6 more , Brett J, Degenhardt L, Oei JL, Pearson SA, Havard A, Tran DT
Addiction · 2026 Jun · PMID 41558849 · Full text
BACKGROUND AND AIMS: To measure the proportion of women in New South Wales, Australia, retained in opioid agonist treatment (OAT) for opioid dependence (OD) during pregnancy and examine how this varies according to treat...
BACKGROUND AND AIMS: To measure the proportion of women in New South Wales, Australia, retained in opioid agonist treatment (OAT) for opioid dependence (OD) during pregnancy and examine how this varies according to treatment and maternal characteristics. DESIGN: Retrospective cohort study using linked population-based data, including OAT records, perinatal, hospital admissions, mental health outpatient services and criminal justice data. SETTING: New South Wales, Australia, January 2004-December 2021. PARTICIPANTS: Pregnancies resulting in childbirth among women receiving OAT during pregnancy. The cohort included 4472 pregnancies among 2821 women receiving OAT during pregnancy. MEASUREMENTS: We defined retention as continuous receipt of OAT from the date of OAT initiation during pregnancy or date of conception (whichever came last) until childbirth. We calculated the proportion of women retained in treatment and 95% confidence intervals (CI) overall, by timing of initiation (pre-conception, first, second and third trimester) and medication type (methadone, buprenorphine) at initiation. We used logistic regression to assess retention variation according to maternal socio-demographic and clinical factors, including morbidities commonly co-occurring with OD, stratified by timing of initiation. Data on dosing, other substance use and psychopharmacological medications were unavailable. FINDINGS: OAT was initiated pre-conception in 74.8% (3346) of pregnancies, during the first trimester in 11.1% (n = 497), second trimester in 8.8% (n = 394) and third trimester in 5.3% (n = 237). Overall, women were retained in OAT for 84.3% (3771) of all pregnancies. Retention was 87.4% (95% CI = 86.3-88.6) with pre-conception initiation; 65.8% (95% CI = 61.6-70.0) in the first trimester; 80.5% (95% CI = 76.5-84.4) second trimester; and 85.2% (95% CI = 80.8-89.7) third trimester. Retention was 72.4% (95% CI = 69.5-75.3) with buprenorphine and 87.7% (95% CI = 86.6-88.9) with methadone. Pregnancies delivered during 2019-2021 were less likely to be retained in treatment compared with those delivered during 2004-2006, regardless of the timing of initiation [pre-conception initiation odds ratio (OR) = 0.49, 95% CI = 0.30-0.79; first trimester initiation OR = 0.29, 95% CI = 0.08-1.07; second/third trimester initiation OR = 0.29, 95% CI = 0.10-0.91). Among women who initiated OAT pre-conception, retention was lower among those whose first antenatal visit occurred after 20 gestational weeks (OR = 0.68, 95% CI = 0.53-0.86), those in their first (OR = 0.72, 95% CI = 0.54-0.97) or second pregnancy (OR = 0.73, 95% CI = 0.56-0.96) and those who initiated on buprenorphine (OR = 0.31, 95% CI = 0.24-0.40) or in a custodial setting (OR = 0.66, 95% CI = 0.44-1.01). CONCLUSIONS: In New South Wales, Australia, from 2004 to 2021, over 84% of women receiving opioid agonist treatment during pregnancy were retained in treatment until childbirth; however, lower retention in later study years and among women initiating buprenorphine, coupled with recent guidelines recommending buprenorphine as first-line therapy during pregnancy, highlights the need for ongoing monitoring and targeted support to improve retention among women who are at higher risk of discontinuation.
Navigating pregnancy and addiction recovery: Patient perspectives on perinatal care interventions for women with opioid use disorder in Kentucky, USA.
Surratt HL, Davis OA, Nelson EO … +7 more , Durr H, Fawcett K, Joy J, Schanbacher BL, Vice M, Bauer JA, Hansen WF
Addiction · 2026 Jun · PMID 41558818 · Full text
BACKGROUND AND AIMS: The state of Kentucky has been heavily impacted by the ongoing opioid crisis in the United States, with high overdose mortality, high prevalence of opioid use disorder (OUD), elevated maternal mortal...
BACKGROUND AND AIMS: The state of Kentucky has been heavily impacted by the ongoing opioid crisis in the United States, with high overdose mortality, high prevalence of opioid use disorder (OUD), elevated maternal mortality and incidence of Neonatal Abstinence Syndrome. Evidence-based care for pregnant people with OUD remains limited in many areas of the state, and patient perspectives are urgently needed to understand the acceptability of intervention approaches, and broader perspectives on prenatal and recovery care in their communities. This study aimed to understand women's experiences with prenatal care and substance use treatment in Kentucky throughout the perinatal period. DESIGN: Data were drawn from a recently completed Patient-Centered Outcomes Research Institute (PCORI) funded comparative effectiveness trial known as PATHHome, whose overarching objective was to study the delivery of a pregnancy-specific educational recovery curriculum for pregnant women treated for OUD in Kentucky. PATHHome was a pragmatic, non-inferiority, cluster randomized trial testing group versus telemedicine interventions for delivering care. We conducted a qualitative study with trial completers. SETTING: PATHHome was conducted in 13 clinical sites across eastern and central Kentucky. PARTICIPANTS: Eligible patient participants were: (1) between ages 18-55, (2) pregnant (between 6 and 32 weeks' gestation), (3) diagnosed with OUD, and (4) being treated with medications for opioid use disorder (MOUD). Thirty-three participants across 10 clinical sites were ultimately interviewed. MEASUREMENTS: Participants were invited to complete an in-depth qualitative interview at the time of their final 6-month postpartum follow-up visit. Interview coding was conducted using a hybrid inductive-deductive approach and consensus coding techniques were used. Coding and analysis were conducted in NVivo. FINDINGS: Systematic analysis of patient experiences revealed four overarching themes: Theme 1. MOUD stigma diminishes the quality of perinatal care for women with OUD, highlighting the need for expanded integration of evidence-based MOUD, prenatal and delivery care; Theme 2. Navigating siloed and inconsistent care system policies contributes to suboptimal delivery experiences and limits parenting opportunities; Theme 3. Maternal engagement in perinatal OUD interventions is enhanced by responsive and adaptable approaches that address patient beliefs, circumstances and histories; and Theme 4. A pregnancy-specific educational recovery curriculum delivered by a supportive, nonjudgmental and multidisciplinary intervention team promotes high acceptability among women on MOUD. CONCLUSIONS: In Kentucky, USA, there appears to be a high level of acceptability for a pregnancy-specific opioid use disorder recovery education intervention among pregnant patients on medications for opioid use disorder (MOUD). Major recommendations include prioritizing the expansion of integrated prenatal and addiction care, including through the use of telehealth in communities with insufficient clinical capacity, and engaging the entire perinatal healthcare team in stigma training and foundational training on MOUD, which may reduce episodes of enacted stigma in the care setting.
Ultra-processed food addiction: A growing international concern.
Schmidt LA
Addiction · 2026 Mar · PMID 41555704 · Publisher ↗
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Understanding the interplay between alcohol use, cannabis use and mental health across the lifespan: A network analysis.
Macedo I, Kroon E, Colyer-Patel K … +5 more , Freichel R, Romein C, Pasion R, Barbosa F, Cousijn J
Addiction · 2026 Jun · PMID 41549816 · Publisher ↗
AIMS: This study aimed to understand the interplay between alcohol use, cannabis use and mental health across the lifespan by addressing the following questions: (1) Do the structure and overall connectivity of mental he...
AIMS: This study aimed to understand the interplay between alcohol use, cannabis use and mental health across the lifespan by addressing the following questions: (1) Do the structure and overall connectivity of mental health symptom networks differ between individuals who use alcohol and those who co-use alcohol and cannabis?; (2) Within co-users, what is the strength of the associations between characteristics of alcohol and cannabis use (quantity/frequency, severity of use-related problems and age of onset) and mental health symptoms?; and (3) Does age moderate these associations among co-users? DESIGN, SETTING AND PARTICIPANTS: Cross-sectional observational study including 740 participants aged 16-81 years, of which 446 used alcohol (57.6% female) and 294 co-used alcohol and cannabis (50.7% female). Data were collected online from English- and Dutch-speaking participants across multiple countries. MEASUREMENTS: Main outcome measures included self-reported severity of mental health symptoms (DSM-Level 1-Cross-Cutting Symptom Measure), quantity/frequency and problematic use of cannabis (Cannabis Use Disorder Identification Test - Revised) and alcohol (Alcohol Use Disorder Identification Test). Using a network approach, interactions between mental health symptoms (12 nodes) were compared between alcohol users and alcohol and cannabis co-users. In co-users, we incorporated detailed measures of alcohol and cannabis use (6 nodes) in the network and assessed the moderating role of age. FINDINGS: The alcohol and cannabis co-use group was characterized by higher quantity/frequency of use, problematic use and severity for all mental health symptoms compared with the alcohol group (Ps ≤ 0.001). Still, the alcohol use and alcohol-cannabis co-use networks did not statistically significantly differ (network invariance test: maximum difference in edge weights = 0.167, P = 0.611, global strength invariance test: global strength difference statistic = 0.265, P = 0.470), with both showing strong connections between anxiety, personality functioning and depression. However, the centrality invariance test revealed a statistically significantly (P = 0.018) higher strength of somatic symptoms in co-use (strength = 1.31) compared with alcohol use (strength = 0.17). When substance use outcomes were included in the co-use network, distinct associations emerged: alcohol-related problems were uniquely linked to anxiety, impaired personality functioning and suicidal ideation (partial cor. = 0.03, 0.01 and 0.01, respectively), while cannabis-related problems were associated with mania and dissociation (partial cor. = 0.05 and 0.02). Age did not moderate these relationships. CONCLUSIONS: Alcohol use and alcohol-cannabis co-use appear to be associated with a range of mental health symptoms, including overlapping and distinct symptom patterns that are similar regardless of age.
Gender differences in the impact of psychological distress on methamphetamine use disorder outcomes and treatment effect.
Amin-Esmaeili M, Byregowda H, Susukida R … +2 more , Mojtabai R, Crum RM
Addiction · 2026 Jun · PMID 41549063 · Full text
BACKGROUND AND AIMS: Methamphetamine use disorder (MUD) is a major public health concern, often complicated by co-occurring psychological distress (PD). Evidence suggests gender differences in both the prevalence of PD a...
BACKGROUND AND AIMS: Methamphetamine use disorder (MUD) is a major public health concern, often complicated by co-occurring psychological distress (PD). Evidence suggests gender differences in both the prevalence of PD and its impact on treatment outcomes. This study examined impacts of PD on MUD treatment outcomes, focusing on gender differences. DESIGN: Secondary analysis of pooled data from five randomized controlled trials of pharmacotherapy for MUD available on the NIDA DataShare site (accessed 19 October 2024). Individual participant data meta-analysis methods were used, adjusting for sociodemographic factors and accounting for heterogeneity across trials. Regression analyses were conducted for total sample and stratified by gender. SETTING: Treatment facilities in the US. PARTICIPANTS: Adults seeking MUD treatment (n = 866). MEASUREMENTS: PD was assessed using the Addiction Severity Index psychiatric domain (≥24.6 cutoff). Outcomes included reductions in methamphetamine use and positive urine tests for methamphetamine and other drugs. FINDINGS: PD was found in 39.9% of participants. PD was more common among women than men [odds ratio (OR) = 1.56, 95% confidence interval (CI) = 1.15-2.12], and among individuals who were younger (ages 35-45 vs. <35: OR = 0.72, 95% CI = 0.61-0.85; >45 vs. < 35: OR = 0.62, 95% CI = 0.44-0.88), had lower education (OR = 1.38, 95% CI = 1.16-1.65), chronic medical conditions (OR = 1.60, 95% CI = 1.16-2.20), history of injection drug use (OR = 1.47, 95% CI = 1.13-1.91) and prior treatment for alcohol use disorder (OR = 2.52, 95% CI = 1.64-3.84). PD was associated with lower odds of reduced use [adjusted OR (aOR) = 0.74, 95% CI = 0.66-0.82] and higher odds of positive methamphetamine urine tests (aOR = 1.27, 95% CI = 1.08-1.49). Stratified analyses revealed a stronger association among women between PD and lower odds of reduced use (aOR = 0.41, 95% CI = 0.23-0.75) and higher odds of positive urine tests for methamphetamine (aOR = 2.18, 95% CI = 1.25-3.81) and other drugs (aOR = 3.16, 95% CI = 1.53-6.47), whereas men showed no statistically significant impact of PD on treatment outcomes. A statistically significant interaction between treatment, gender and PD (P < 0.001) indicated that women without PD benefited more from treatment than those with PD, a pattern not mirrored in men. CONCLUSION: Psychological distress appears to negatively impact outcomes for MUD and the effects of MUD treatment, particularly among women. Integrated psychological interventions, tailored by gender, may enhance treatment efficacy for individuals with co-occurring MUD and psychological distress.
Quitting trajectories of Hong Kong Chinese smokers receiving behavioral smoking cessation interventions: A post hoc analysis of eight randomized controlled trials.
Zeng Y, Wu YS, Luk TT … +8 more , Zhao SZ, Guo Z, Li Y, Tong HSC, Lai VWY, Cheung YTD, Lam TH, Wang MP
Addiction · 2026 Jun · PMID 41546550 · Publisher ↗
BACKGROUND AND AIMS: Characterizing distinct quitting trajectories may inform tailored behavioral smoking cessation interventions. We identified the quitting trajectories and associated characteristics in Hong Kong Chine...
BACKGROUND AND AIMS: Characterizing distinct quitting trajectories may inform tailored behavioral smoking cessation interventions. We identified the quitting trajectories and associated characteristics in Hong Kong Chinese smokers. METHODS: Data were from eight randomized controlled trials nested within the annual Smoking-free Community Campaign ('Quit-to-Win' Contest) from 2014 to 2021. The trials were two- or three-arm evaluating the effectiveness of behavioral smoking cessation interventions in 8300 adult daily smokers who were proactively recruited from communities across Hong Kong and followed-up at 1, 2, 3 and 6 months. Daily cigarette consumption was collected at baseline and follow-ups for identifying quitting trajectories by group-based trajectory modeling based on relative changes in cigarette consumption (vs. baseline) over four follow-up assessment points. Multinomial logistic regressions were used to yield relative risk ratios (RRRs) for the trajectories by baseline smoking-related characteristics, adjusting for sex, age, economic status and education attainment. RESULTS: Four quitting trajectories were identified, including quitters (4.6%), relapsers (6.8%), reducers (54.8%) and persistent smokers (33.8%). Compared with persistent smokers, smokers in the other 3 trajectories were associated with having previous quit attempts, higher intention to quit and perceived higher importance and confidence in quitting (all P < 0.05). Quitters [adjusted RRR (aRRR) = 0.59, 95% confidence interval (CI) = 0.62-1.00] and relapsers (aRRR = 0.75, 95% CI = 0.61-0.91) reported lower nicotine dependence vs. persistent smokers, whereas reducers showed higher nicotine dependence (aRRR = 1.39, 95% CI = 1.25-1.55) at baseline. Relapsers and reducers perceived higher difficulty of quitting (all P < 0.05). When compared with quitters, relapsers had higher intention to quit within 7 days (aRRR = 2.32, 95% CI = 1.64-3.28) and perceived higher importance (aRRR = 1.17, 95% CI = 1.09-1.25) and confidence (aRRR = 1.10, 95% CI = 1.04-1.17) in quitting, while reducers showed lower intention to quit within 7 days (aRRR = 0.59, 95% CI = 0.45-0.77) and perceived lower confidence in quitting (aRRR = 0.91, 95% CI = 0.86-0.95). Subgroup analysis of different interventions showed similar trajectory shapes and group probabilities. CONCLUSIONS: Chinese smokers who joined behavioral smoking cessation trials in Hong Kong appear to have four quitting trajectories, each with associated characteristics, which may help predict the potential quitting trajectories and inform future interventions.
Varenicline for cannabis use disorder: A randomized controlled trial.
McRae-Clark AL, Gray KM, Baker NL … +6 more , Sherman BJ, Tolliver B, Burt J, Steplight A, Chapman E, Wagner A
Addiction · 2026 Jan · PMID 41536001 · Publisher ↗
BACKGROUND AND AIMS: Although cannabis use is widespread and prevalence of cannabis use disorder (CUD) is increasing, limited advancements have been made in CUD medication development. The objective of this study was to...
BACKGROUND AND AIMS: Although cannabis use is widespread and prevalence of cannabis use disorder (CUD) is increasing, limited advancements have been made in CUD medication development. The objective of this study was to test the efficacy of varenicline with medical management for reducing cannabis use in treatment-seeking individuals with CUD. DESIGN: A phase 2, randomized, double-blind, parallel group, placebo-controlled trial was conducted. SETTING: Two outpatient research clinics in South Carolina, USA, from February 2020 to February 2023. PARTICIPANTS: Eligible participants met Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for CUD and used cannabis a minimum of 3 days per week. One hundred and seventy-four participants were randomized to either varenicline (n = 90) or placebo (n = 84) stratified by smoking status and sex. INTERVENTIONS: Varenicline (titrated to goal dose of 1 mg twice daily) or matching placebo for 12 weeks. Medical management was provided weekly. MEASUREMENTS: Primary outcome measure was reduction in total number of cannabis use sessions at each weekly visit (weeks 6-12). FINDINGS: There was no main effect of treatment on reduction of total number of cannabis use sessions per week during weeks 6 through 12 [between group difference (Δ) = 1.7; 95% confidence interval (CI) = -1.0 to 4.7; P = 0.41]; however, a statistically significant treatment by sex interaction was found (F = 5.1; P = 0.026), with a statistically significant effect of varenicline on reduction of cannabis use sessions per week observed in men (Δ = 4.2; 95% CI = 0.6-7.8; P = 0.04) but not women (Δ = -1.4; 95% CI = -5.7 to 3.0; P = 0.18). CONCLUSIONS: Varenicline with medical management resulted in decreased cannabis use among men with cannabis use disorder seeking treatment, but not women (no effect was observed on the overall sample of treatment-seeking individuals with cannabis use disorder).
Authorization of storefront recreational cannabis retailers and cannabis-related healthcare encounters: A local-level spatial difference-in-differences analysis in California, United States.
Han B, Gunadi C, Shi Y
Addiction · 2026 May · PMID 41535232 · Publisher ↗
BACKGROUND AND AIMS: While half of the states in the United States of America (USA) have approved statewide retail sales of cannabis, local governments retain the authority to opt in or out of authorizing storefront recr...
BACKGROUND AND AIMS: While half of the states in the United States of America (USA) have approved statewide retail sales of cannabis, local governments retain the authority to opt in or out of authorizing storefront recreational cannabis retailers. This study aimed to examine local-level associations between the authorization of storefront recreational cannabis retailers and cannabis-related healthcare encounters in California, USA. DESIGN: A secondary data analysis of cannabis-related healthcare encounters across 482 cities in California from 2010 to 2020. A spatial difference-in-differences model was employed at the city-quarter level to assess both intracity and intercity associations, controlling for time-varying city-level policies and sociodemographic factors while accounting for spatial influence over neighboring cities. SETTING: California, USA. PARTICIPANTS: All California residents from 2010 to 2020. MEASUREMENTS: Three cannabis-related healthcare encounter outcomes were assessed: (1) population-adjusted emergency department visits, (2) population-adjusted inpatient discharges, and (3) a binary indicator of any calls to poison centers. The primary policy variable was whether a city authorized storefront recreational cannabis retailers. FINDINGS: No statistically significant intracity association was found between the authorization of storefront recreational cannabis retailers and rate of emergency visits [-0.14 percentage points; 95% confidence interval (CI) = -18.24 to 17.97; P = 0.988], rate of inpatient discharges (-6.11 percentage points; 95% CI = -17.58 to 5.36; P = 0.297) or probability of any poison center calls (-2.58 percentage points; 95% CI = -6.18 to 1.02; P = 0.161). For intercity associations, authorizing storefront recreational cannabis retailers was associated with a 6.75 percentage point decrease (95% CI = -12.46 to -1.03; P = 0.021) in the probability of any poison center calls in neighboring cities, suggesting that local cannabis policies may have influence extending beyond their immediate jurisdictions. CONCLUSIONS: In California, USA, the local authorization of storefront recreational cannabis retailers appears to be associated with a reduction in cannabis-related poison center calls in neighboring cities rather than within the policy-implementing cities.
Target trial emulation for addiction research-A useful method but not a panacea.
Clare PJ, Bharat C
Addiction · 2026 Mar · PMID 41531346 · Publisher ↗
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Commentary on Dobbie et al.: Preventing adolescent gambling-related harm-Is a universal approach sufficient?
Richard J
Addiction · 2026 Apr · PMID 41531317 · Full text
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Trends in fentanyl-containing drug samples seized by law enforcement agencies across Canada.
Ledlie S, Garg R, Leece P … +4 more , Kolla G, Hyshka E, Tadrous M, Gomes T
Addiction · 2026 Jun · PMID 41531299 · Full text
BACKGROUND AND AIMS: Canada's drug toxicity crisis has been largely attributed to a volatile fentanyl-dominated unregulated drug supply with increasing reports of fentanyl detected in combination with benzodiazepines, st...
BACKGROUND AND AIMS: Canada's drug toxicity crisis has been largely attributed to a volatile fentanyl-dominated unregulated drug supply with increasing reports of fentanyl detected in combination with benzodiazepines, stimulants and xylazine. Although rates of opioid-related harms vary significantly by region, it remains unknown how the composition of the unregulated drug supply differs across Canada. Therefore, we sought to describe trends in Canadian fentanyl-containing drug seizures nationally and compare trends by province/territory. DESIGN: Repeated cross-sectional analysis between February 2020 and December 2024. SETTING AND CASES: Fentanyl-containing drug samples seized by law enforcement agencies across Canada were analyzed by Health Canada's Drug Analysis Service, with test results made publicly available. MEASUREMENTS: Counts and crude rates of fentanyl-containing drug seizures, with the population of each province/territory used to calculate rates per 100 000. We described the number of notable drug classes (e.g. benzodiazepines, stimulants, non-fentanyl opioids, etc.) and chemical substances identified within each drug seizure and used the Cochrane Armitage Test for Trend to look for significant changes over time. All analyses were conducted overall and stratified by province/territory. FINDINGS: We identified 71 996 fentanyl-containing drug seizures over the study period, with the quarterly number of seizures increasing by 24.4% (from 2640 in 2020 to 3284 in 2024) across Canada. This varied by province/territory, with the highest annual rates of fentanyl-containing seizures in 2024 reported in British Columbia (60.4 per 100 000) and Alberta (52.3 per 100 000). Among fentanyl types, we observed statistically significant increases (P < 0.001) in the detection of para-flurofentanyl (0.0% to 46.3%) and methylfentanyl (0.0% to 28.6%). Additionally, there was a notable rise in the annual proportion of seizures in which benzodiazepines (13.4% to 40.2%) or xylazine (1.5% to 18.9%) were detected. Approximately half of all seizures contained fentanyl in combination with at least one other drug class and over 95% contained fentanyl in combination with at least one other chemical substance. CONCLUSIONS: Across Canada from 2020 to 2024, there has been a 24% increase in fentanyl-containing drug seizures in which multiple substances are detected, most notably benzodiazepines, xylazine and potent fentanyl analogues within a single sample.
Clinical factors linked to xylazine exposure in emergency department patients with illicit opioid overdose.
Love JS, Vargas-Torres C, Aldy K … +10 more , Brent J, Wax P, Culbreth R, Krotulski A, Campleman S, Logan B, Abston S, Li S, Manini AF, Fentalog Study Group
Addiction · 2026 May · PMID 41531011 · Full text
BACKGROUND AND AIMS: Xylazine, an alpha-2 agonist used in veterinary anesthesia, is increasingly detected in the illicit opioid supply but little is known about the patient level factors associated with xylazine in non-f...
BACKGROUND AND AIMS: Xylazine, an alpha-2 agonist used in veterinary anesthesia, is increasingly detected in the illicit opioid supply but little is known about the patient level factors associated with xylazine in non-fatal opioid overdose. This study aimed to determine the demographic and clinical factors associated with xylazine detection among emergency department (ED) patients with opioid overdose. DESIGN: Observational study. The Toxicology Investigators Consortium (ToxIC) Fentalog Study is a multicenter, prospective cohort of adult patients with suspected opioid overdose. This analysis included patients enrolled from September 2020 to September 2023. SETTING: In this multicenter study, participating sites included 10 institutions across 9 states in 4 regions of the United States (US): Northeast, Southeast, Midwest and West. PARTICIPANTS: Patients were eligible for Fentalog Study inclusion if they were at least 18 years old, had a suspected opioid overdose and had waste blood available for toxicologic analysis. Only patients with qualitative serum detection of illicit opioids and/or xylazine were included in the final cohort. Of 5554 patients screened, 1289 were eligible for Fentalog Study inclusion. MEASUREMENTS: Based on results of liquid chromatography with a quadrupole time-of-flight mass spectrometer (LCQTOF-MS) and/or liquid chromatography with a triple quadrupole mass spectrometer (LC-QQQ-MS), patients were categorized into those with xylazine detected (positive cases) and without xylazine detected (negative controls). To determine clinical variables associated with xylazine detection, the primary outcome of interest was qualitative detection of xylazine on serum sampling by LCQTOF-MS. FINDINGS: Xylazine was detected in 238 patients. Patients with xylazine were primarily male (78%), white (48%), non-Hispanic (82%) and located in the Northeast US (75%). Bradycardia on initial ED vital signs was associated with higher likelihood of xylazine detection (adjusted odds ratio = 2.11, 95% confidence interval = 1.06-4.06). CONCLUSIONS: Xylazine detection among emergency department opioid overdose patients appears to be more prevalent in the Northeast US and bradycardia appears to be a statistically significant clinical predictor.
Commentary on Getty et al.: Complementarity of harm reduction and contingency management.
Roll JM
Addiction · 2026 Apr · PMID 41527198 · Full text
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